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脊髓损伤病人的运动功能评定

胥少汀 刘树清 李京生 单建林 姜金卫 梁毅

  【摘要】目的 脊髓损伤(SCI)病人的分级多采用Frankel分级标准,我们根据260例SCI病人的观察,认为对病人活动功能影响最大的是运动功能与排尿功能,且上肢与下肢评级标准不尽相同,从而对分级提出改进意见。方法 本组260例,伤后观察时间达1以上者156例,占60%。损伤部位:C3-4~T190例,T2~1037例,T11~L1105例,L2~328例。脊髓损伤类型:完全截瘫169例,不全截瘫64例,中央脊髓损伤16例,脊髓半侧损伤5例,圆锥损伤6例。上肢运动功能目的为持物,其分级是参考Moberg,Zancolli,Freehafer等手功能重建的分级而提出的。下肢之目的为移动躯体,以可用拐步行为C级进行分级。结果 上肢运动功能分级:A.仅能屈肘,5例;B.可屈肘与伸腕、肌力Ⅲ级,16例;C.除屈肘、伸腕Ⅲ级外,还可屈腕或伸指或伸肘或屈指,肌力Ⅱ~Ⅲ级,14例;D.上肢肌肉除手内在肌外,均恢复至Ⅲ级,26例;E.上肢各肌力均在Ⅲ级以上,基本完全恢复功能,25例。4例不详。下肢运动功能:A.下肢各肌肌力0级,139例(56.5%);B.有1~3块肌肉肌力Ⅰ~Ⅱ级,10例;C.股四头肌、股内收肌肌力Ⅲ级,16例;D.下肢大部肌肉肌力Ⅲ级或全部肌力Ⅱ级,67例;E.下肢各肌肌力Ⅲ-Ⅳ级28例。排尿功能:A.尿失禁6例;B.反射性排尿,膀胱过度反射需手压协助16例;C.反射性排尿143例;D.反射性排尿,可稍有知觉或控制67例;E.可控制正常排尿28例。结论 260例脊髓损伤观察,上肢功能,按Frankel分级,A级者56例;按本文分级为A14例,B14例,C26例,能更确实反映出上肢运动功能,下肢C级可用拐步行,系腰神经根恢复应列为Ⅰ级,因而提出改进的分级标准,颈脊髓伤按上肢、下肢、排尿运动功能评定,胸腰脊髓马尾伤,按下肢与排尿功能评价,称ULSM评分。
  【关键词】脊髓损伤运动排尿

Evaluation of Motor Function of the Spinal Cord in Patients With Spinal Cord Injury

XU Shaoting, LIU Shuqing,LI Jingsheng, et al.
Department of Orthopaedics, General Hospital of Beijing Military Area, Beijing 100700

  【Abstract】 Objective To modify the Frankel s classification for evaluation of paraplegias. Method Motor function were evaluated in 260 patients with spinal cord injury( SCI).Of those,156 patients were followed up for a period of over one year.The distribution of injured segments was C 3-4~ T 1 in 90,T 2-10 in 37 ,T 11~L 1 in 105 and L 2,3 in 28 cases.The type of spinal cord injury were classified as complete spinal cord injury in 169,incomplete in 64, central syndrome in 16, Brown-Sequard syndrome in 5, conus injury in 6. The evaluation of the motor function in upper limbs were referred to the reconstruction of the function in hand by Moberg, Zancolli and Freehafer. While in lower limbs,the ability of walking is used as the base of grading. Results Motor function in upper limbs were classified as A in 5, B in 16, C in 14, D in 26 and E in 25. Motor function in

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